OVERVIEW

What is bronchiectasis?

Bronchiectasis refers to the destruction of normal structures such as bronchial wall smooth muscle and elastic fibers caused by various factors, including recurrent suppurative infections, bronchial obstruction and traction, and congenital factors, leading to bronchial deformation and permanent dilation.

Typical symptoms include chronic cough, production of large amounts of purulent sputum, and recurrent hemoptysis. "Bronchiectasis" is often abbreviated as "bronchiectasis."

What are the types of bronchiectasis?

Based on morphological differences, bronchiectasis can be classified into three types: cylindrical bronchiectasis, varicose bronchiectasis, and cystic bronchiectasis.

Where does bronchiectasis occur?

Bronchiectasis can occur in both lungs, either diffusely or localized, affecting only specific airways. The location of bronchiectasis is primarily related to the underlying causative factors.

Generally, bronchiectasis caused by bacterial infections tends to be diffuse, while tuberculosis-induced bronchiectasis often manifests as localized bronchial dilation due to traction from tuberculous lesions.

SYMPTOMS

What are the common symptoms of bronchiectasis that can aid in diagnosis?

The following symptoms may indicate bronchiectasis:

• Persistent, long-term cough with sputum, often producing large amounts of yellow-green purulent sputum.

• Recurrent hemoptysis, ranging from blood-streaked sputum to small or large amounts of blood.

• Frequent "colds" or "bronchitis," accompanied by purulent sputum or even hemoptysis during flare-ups.

What are the symptoms of acute exacerbation in bronchiectasis?

Bronchiectasis often worsens acutely due to infection.

If at least one of the following symptoms worsens—such as increased sputum volume or purulence, worsening shortness of breath, increased coughing, declining lung function, heightened fatigue—or new symptoms appear (e.g., fever, pleurisy, hemoptysis), it usually signals an acute exacerbation requiring prompt medical treatment.

Why do bronchiectasis patients experience hemoptysis?

The bronchi are surrounded by a rich vascular network resembling a fishing net. As bronchiectasis progresses, these blood vessels are also affected, often becoming dilated and prone to rupture. Blood entering the bronchi is then expelled, causing hemoptysis.

Additionally, bronchiectasis patients are susceptible to recurrent infections. Inflammatory damage to the bronchial mucosa and underlying blood vessels further increases the risk of hemoptysis.

Why do bronchiectasis patients produce large amounts of purulent sputum?

The airway epithelium is lined with cilia that constantly move, sweeping mucus outward like brooms and even helping clear bacteria.

In bronchiectasis patients, impaired ciliary structure or function—whether due to inherent abnormalities or recurrent infections—disrupts mucus clearance, leading to mucus accumulation in the airways and excessive purulent sputum.

Why are bronchiectasis patients prone to recurrent infections?

• Some patients have weakened or defective immune function.

• Abnormal mucociliary clearance prevents effective removal of microorganisms.

• Bacterial infections further damage mucociliary clearance.

• Pathogens colonize the respiratory tract. While coexisting harmlessly under normal conditions, they proliferate rapidly when immunity declines, compromising health.

CAUSES

What Causes Bronchiectasis?

Congenital Factors: Congenital factors refer to conditions present at birth, which may be genetically inherited. However, symptoms may not appear immediately after birth but worsen over time, eventually leading to the onset of the disease. The main causes include:

• Bronchial Cartilage Hypoplasia: Patients have congenital bronchial dysplasia, presenting as diffuse bronchiectasis with a familial tendency.

• Congenital Tracheobronchomegaly (Mounier-Kuhn Syndrome): An autosomal recessive disorder characterized by congenital connective tissue abnormalities, weak bronchial walls, and significant dilation of the trachea and main bronchi.

• Marfan Syndrome: An autosomal dominant disorder involving connective tissue degeneration, which may lead to bronchiectasis, often accompanied by ocular symptoms, arachnodactyly, and heart valve lesions.

• Kartagener Syndrome: A triad of bronchiectasis, chronic sinusitis or nasal polyps, and situs inversus. It primarily manifests as recurrent respiratory infections, hemoptysis, sinusitis, and dextrocardia.
  Also known as immotile cilia syndrome or familial bronchiectasis, it is an autosomal recessive genetic disorder with a familial tendency, occurring in the same or alternate generations, often linked to consanguineous marriages.

• Yellow Nail Syndrome: Characterized by yellow, thickened nails, lymphedema, and chronic pleural effusion. Also called chronic hereditary lymphedema or congenital lymphedema, it is often associated with bronchiectasis and unilateral or bilateral transudative pleural effusion.
  Mostly genetic, it may accompany yellow nails and complications such as hepatobiliary diseases, hemolysis, hypothyroidism, chronic adrenal insufficiency, nephrotic syndrome, or carotenemia.

Acquired Factors: Acquired factors primarily develop during growth or adulthood due to external causes. The main acquired causes of bronchiectasis are bronchial infections and obstructions.

Additionally, immune system deficiencies and abnormalities in the bronchial ciliary mucus clearance system can also lead to bronchiectasis.

Can Bronchiectasis Occur in Children?

Yes, children can develop bronchiectasis. Pediatric cases account for approximately 0.3–0.6‰ of hospitalized cases.

What Are the Common Causes of Bronchiectasis in Children?

Pediatric bronchiectasis is classified into congenital and acquired types, with acquired cases being more common. Common causes include immune deficiencies, severe pneumonia, tuberculosis, primary ciliary dyskinesia, and bronchial foreign bodies.

DIAGNOSIS

What tests are needed to diagnose bronchiectasis?

• Chest X-ray: Chest X-ray is the most commonly used and widespread clinical examination. However, it cannot indicate the cause of bronchiectasis based on its findings, and for some mild cases, the chest X-ray may appear normal.

• High-resolution CT: High-resolution CT can clearly show the location and characteristics of the dilation, suggesting the specific cause of bronchiectasis.

• Sputum examination: Indicates whether there is a bacterial infection and the type of bacterial infection, providing guidance for antibiotic treatment.

• Pulmonary function test: Helps assess the extent of lung function impairment, whether there is obstructive lung dysfunction, or increased airway sensitivity, to determine appropriate specialized treatment.

• In addition, depending on the situation, tests such as sinus CT, bronchoscopy, immune function tests, ciliary function tests, PPD, rheumatoid factor, and antinuclear antibody tests may be required to further identify the cause.

Do bronchiectasis patients need regular follow-up high-resolution CT scans?

Generally, bronchiectasis patients do not require regular follow-up high-resolution CT scans.

However, patients with humoral immune function deficiencies (e.g., common variable immunodeficiency, X-linked agammaglobulinemia) should undergo regular follow-up scans to assess disease progression.

Is bronchoscopy necessary for bronchiectasis?

Bronchoscopy is not routinely required for bronchiectasis patients. Children with single-lobe bronchiectasis or adults with localized lesions may undergo bronchoscopy to rule out foreign body obstruction.

For patients with repeatedly negative sputum cultures and poor treatment response, protected specimen brushing or bronchoalveolar lavage via bronchoscopy can be performed to obtain lower respiratory tract secretions, identify the specific pathogen, and select targeted antibiotics.

TREATMENT

What are the treatment measures for hemoptysis caused by bronchiectasis?

Conservative treatment for hemoptysis includes the use of antibiotics and hemostatic drugs. Hemostasis can also be achieved via bronchoscopy. When these methods fail to resolve the issue, surgical resection or bronchial artery embolization (discussed separately later) may be considered.

How to treat bacteria causing bronchiectasis?

Based on the condition, the likely type or specific bacterial infection is assessed, and empirical antimicrobial therapy targeting the bacteria is initiated. Sputum cultures and drug sensitivity tests are performed, and medication is adjusted according to the test results. Outpatients often receive empirical treatment.

The optimal duration of antimicrobial therapy during acute exacerbations remains uncertain, but empirical recommendations suggest a treatment course of around 14 days for all acute exacerbations.

If bronchiectasis is caused by tuberculosis, anti-tuberculosis drugs are used, requiring a much longer treatment course, often exceeding six months.

What other treatment methods are available for bronchiectasis?

In addition to infection control, bronchiectasis treatment focuses on the following aspects:

• Treating the underlying disease; for example, using immunoglobulin therapy for hypogammaglobulinemia.

• Promoting mucus clearance through postural drainage and expectorants.

• Improving airway obstruction. Bronchodilators can relax the smooth muscles around the airways, alleviating obstruction and facilitating mucus expulsion.

• For severe and extensive localized disease unresponsive to medication, partial lung resection (segmentectomy or lobectomy) may be an option. Additionally, lung transplantation can be considered for end-stage bronchiectasis.

When do bronchiectasis patients require surgical treatment?

Surgical intervention, such as partial lung resection (segmentectomy or lobectomy), may be considered for patients with recurrent massive hemoptysis unresponsive to conservative treatment, provided the contralateral lung has adequate function, no active lesions, and no contraindications, after identifying the bleeding site.

What are the treatment options for hemoptysis in bronchiectasis?

• Vascular interventional therapy:

  • Also known as bronchial artery embolization, this involves locating the bleeding vessel and blocking it to stop bleeding. Specifically, bronchial artery angiography is performed to identify the affected vessel, which is then embolized (using absorbable gelatin sponges, coils, etc.) to cut off blood supply and achieve complete hemostasis.

  • However, this method has limitations, such as difficulty in precisely locating the bleeding vessel. It is also unsuitable for patients allergic to iodine or with renal insufficiency, as contrast agents cannot be used. Due to radiation risks, it is contraindicated in pregnant women.

• Airway interventional therapy:

  • Also called bronchial interventional occlusion, this involves locating the bleeding or diseased bronchus and injecting an occluding agent (e.g., biological glue, thrombin) to block it. The trapped blood coagulates, stopping the bleeding.

  • This is generally used when arterial embolization is not feasible.

Are expectorants necessary in bronchiectasis treatment?

Bronchiectasis patients often exhibit excessive mucus due to airway hypersecretion and impaired mucus clearance, leading to mucus retention. Oral expectorants (mucolytics) can be used during acute exacerbations to promote mucus expulsion.

Is inhaled steroid therapy needed for bronchiectasis?

Inhaled corticosteroids (ICS) can alleviate chronic airway inflammation, reduce sputum production, and improve quality of life.

Currently, ICS is not routinely recommended for all bronchiectasis patients, except for those with confirmed airway hyperresponsiveness or concurrent asthma, who may benefit from regular use under medical guidance.

Do bronchiectasis patients need home ventilators?

Generally, bronchiectasis patients do not require home ventilators. However, for end-stage patients with chronic respiratory failure, ventilators may partially improve their quality of life.

How can bronchiectasis patients promote mucus clearance in daily life?

• Postural drainage: Adopting specific positions to use gravity for expelling secretions from the airways.

• Percussion and vibration: Cupping the hand and clapping the chest or using mechanical vibrators to loosen secretions for easier coughing or drainage, often combined with postural drainage.

• Active breathing exercises: Patients should practice breathing techniques to aid mucus clearance. Each cycle includes three parts: deep breathing (chest expansion), forced exhalation, followed by relaxation and slow inhalation.

• Assisted mucus clearance techniques: Including airway humidification and nebulized medication inhalation.

Can bronchiectasis be cured?

Generally, the permanent structural damage to bronchial walls cannot be reversed with current medications. For localized bronchiectasis, surgical removal of the affected bronchi may be an option.

However, some pediatric cases, such as those caused by bronchial foreign bodies, may see gradual recovery of the dilated bronchi after foreign body removal.

DIET & LIFESTYLE

What should bronchiectasis patients pay attention to when experiencing hemoptysis?

• Do not panic when hemoptysis occurs. Avoid strenuous activity to prevent further damage to blood vessel walls.

• For patients with unilateral bronchiectasis, it is best to rest in the lateral decubitus position on the affected side to avoid suffocation caused by massive hemoptysis. For those with bilateral bronchiectasis, rest in the lateral decubitus position on the more severe or actively bleeding side.

• Seek medical attention promptly to determine the cause of hemoptysis and receive treatment. If there is significant hemoptysis accompanied by symptoms such as difficulty breathing, palpitations, or fatigue, immediate medical attention is required.

PREVENTION

How to Prevent Bronchiectasis in Children?

Lower respiratory tract infections and tuberculosis during childhood are the most common causes of bronchiectasis in China. Therefore, the following measures are recommended to prevent bronchiectasis:

• Actively prevent and treat lower respiratory tract infections in children;
• Get vaccinated against measles, whooping cough, and tuberculosis (BCG vaccine);
• Seek timely treatment for tuberculosis.